Category Archives: Cytomegalovirus infection

CMV infection of the ileum has rarely been reported. One of these reports involved a patient with CMV infection of the ileum and a squamous cell carcinoma of the tongue, although the patient was not immunocompromised. In another study , CMV infection was detected in a patient with Crohn’s disease presenting with severe ileal bleeding. Vega et al studied nine steroid-resistant IBD patients and found CMV infection in one of the two Crohn’s disease patients with both colon and ileum involvement after the operation. The histopathological examination of our patient’s specimen revealed CMV inclusion bodies in both the ileum and colon.

However, there are some reports suggesting that CMV infection affects the clinical course of IBD. Cases of patients with self-limited colitis and colonic ulcers associated with CMV have been reported . An association between CMV infection and the onset of IBD has also been presented. In the present case, CMV serological markers of the patient were not studied preoperatively. However, the patient’s clinical condition deteriorated while he was in remission with low-dose steroid therapy, which suggested that Crohn’s disease may have preceded CMV infection or developed concomitantly.

The immunohistochemical examination clearly indicated that these nuclei were strongly positive with anti-CMV antibody (Figure 3). A diagnosis of Crohn’s ileocolitis with superimposed CMV infection was established in light of these findings. Six months following the first operation, the patient underwent another surgery for bowel continuity. Postoperative follow-up was uneventful at one year. CMV is a common virus which infects approximately two-thirds of the general population. CMV has been reported to act on the intestine as a nonpathogenic bystander.

Because of the dense adhesion and inflammation, ‘en bloc’ resection of this inflammatory mass was performed (Figure 2). End ileostomy was performed and the distal transverse colon was oversewn. After the operation, the patient gradually improved. Gross examination of the surgical specimen revealed linear ulcers throughout the small intestine and the colon. There were segmental strictures, peri-ileal abscesses and enteroenteric fistula formation in the ileal loops where the bowel wall was thickened.

Immune markers including antinuclear antibodies, antimitochondrial antibodies, antismooth muscle antibodies and antineutrophil cytoplasmic antibodies were all negative. The patient was diagnosed with an exacerbation of Crohn’s disease, and an elemental diet, mesalamine therapy at a daily dose of 4 g and prednisolone therapy at a daily dose of 60 mg were started. The radiological examination of the small intestine demonstrated narrowing of the terminal ileum and thickening on the wall of the small bowel.

A 50-year-old man was admitted to the gastroenterology clinic at the Ankara University Medical School in Turkey with complaints of fever, abdominal pain and watery diarrhea. The history revealed Crohn’s disease that had been first diagnosed three years before. He had been in a stable condition on mesalamine (4 g/day) and low-dose steroids (10 mg/day) for three years until four weeks before admission. On admission, the patient appeared to be chronically ill.

Cytomegalovirus (CMV) is a herpes virus that infects 40% to 100% of adults in different populations by their fourth decade of life . However, CMV infection is usually asymptomatic in humans.

CMV infection has been described as an opportunistic infection found in patients following renal or bone marrow transplantation, AIDS, hematological malignancies or during treatment with chemotherapy or corticosteroids. It has a severe clinical course and may be fatal unless treated early on . The disease may present with a more severe clinical course in the elderly and neonates, and patients with comorbidities such as cancer.